By Claire Bearden, Mimi Fetzer, Elizabeth Heck, Kelsie Lewis

http://www.crystalinks.com/anorexia.html

Elizabeth Heck

 Highly active 15 year old female cross-country runner (2 years) Friends include athletes only Wants to maintain a slim, muscular, athletic physique
States she is overweight and not muscular enough Complains about hips Fears weight will affect speed

Was 50th percentile for weight

Lost 6.8kg (15lbs) last year

Now in 5th percentile

Increase intensity level to maintain weight of 41kg (90lbs)

 Eats 900-1000 kcals/day

High protein 80-100g Low fat Low carbohydrates

Occasionally will eat high fat and sugar meals

Denies vomit, laxative, enemas, diuretics

24 hours before the race she eats 2 high carb meals

 Menses started at age 12

Abruptly stopped (8 months ago)

Muscle cramping (2 weeks) Headaches (2 weeks) Abdominal pain & burning sensation in chest (6 months)
Improves with antacids and smaller more frequent meals

Fainted during 5k race

Denies heart pounding, shortness of breath, visual change

An illness associated with extreme emotions, attitudes, and behaviors towards weight and food issues that can result in devastating consequences
1. Anorexia Nervosa 2. Bulimia Nervosa 3. Binge-Eating 4. Eating Disorder Not Otherwise Specified

 Anorexia Nervosa: 90%Female, 10% male Bulimia Nervosa: Female to Male (10 to 1)

Caucasian middle-class females

now it is being found in other ethnicities and

socioeconomic groups
Westernized ideal body type
unrealistic expectations for body image
Distorted body thoughts

 Key features
Refusal to maintain normal body weight Intense fear of gaining weight/ extreme thinness Restricted food intake

Distorted body image

Amenorrhea/infertility

Subtypes
Restricting Non-restricting

 Brittle hair and nails, dry skin, lanugo Drop in body temperature Osteoporosis/short stature Bowel problems
Constipation
Abdominal pains

Low blood pressure, slowed breathing and pulse Fainting, fatigue or lightheadedness

Muscle loss and weakness

Anemia Dehydration resulting in kidney failure
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&docid=VW7p8z3IT9vPjM&tbnid=YEK7N6nVKgpZqM:&ved=0CAQQjB0&url=http %3A%2F%2Forangeoctoberskies.blogspot.com%2F2010%2F12%2Fdisorders-shmismorders-part1.html&ei=xFeJUoCeHYe6iwL1qIGIDA&bvm=bv.56643336,d.cGE&psig=AFQjCNHp15QmeI5F4HvRnUWW5Wo7jiuBNA&ust=1384818711587157

 Key features
Recurrent episodes of binge eating A feeling of lack of control over eating

during the binge Some form of purging food to prevent weight gain Persistent over concern with body weight and shape
Subtypes
Purging
Non-purging

 Menstrual cycle abnormalities/infertility Swollen salivary glands Damaged esophagus and decaying teeth from stomach acid by self-induced vomiting Chronic gastrointestinal irregularity and distress from abnormal eating and elimination

habits and laxative abuse

Electrolyte imbalance from dehydration can lead to irregular heartbeat/heart failure

 Eating large amounts of food uncontrollably

Does not compensate weight gain with

excessive exercise or purging

Binge-eating episodes occurring at least two

days/week
At least six months

Criteria
Eating rapidly Eating alone Eating when not hungry or until uncomfortably

full Feelings of disgust

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&docid=CYX6BHjSlkgcGM&tbnid=ysVpKRbLQfL11M:&ved=0CAQQjB0&url=http%3A%2F%2Frese archonmedical.com%2F2012%2F12%2Feating-disorders%2F&ei=r1iJUvC8DsiZjAKhIGgAQ&bvm=bv.56643336,d.cGE&psig=AFQjCNHEx7BMeL9B6azipOgbll8pTx_Y7Q&ust=1384819211766035

 Any combination of signs and symptoms of anorexia, bulimia, and/or binge-eating Other examples
Purging disorder Orthorexia Spitting out food after chewing it Diabulimia in type 1 diabetics

Kelsie Lewis

 General: Thin, muscular, looked younger than her age, sad, and anxious Skin: Dry(dorsum of hand) HEENT:
Pale face No palpable goiter or dental erosions Gag reflex somewhat diminished Enlarged salivary glands

Developmental: Tanner 3

Neurologic: Decreased reflexes in upper and lower extremities

RKs Values
Temperature: 96F Heart Rate: 68 BPM Respiration: 14 BPM Blood pressure: 90/62 Current weight: 41 kg =90 lbs
Ideal body weight: 53 kg=116 lbs

Normal Values
Temperature: 97.4-98.8F Heart Rate: 66-86BPM Respiration: 14 BPM Blood pressure: 94-116/58-74 Weight: 4
5.4-67.6 kg =100-149lbs

BMI:15.6

BMI:18.2-25.4

Height: 162 cm =54

Height: 154-169cm =51-57

RKs Values
Sodium: 142 mEq/L Potassium: 2.5 mEq/L Co2: 32 mmol/L Calcium: 8.2 mg/dL Phosphate: 4.2 mg/dL Albumin: 3.5 g/dL

Normal Values
Sodium: 136-145 mEq/L Potassium: 3.5-5mEq/L Co2: 25-30 mmol/L Calcium: 8.7-9.2 mg/dL Phosphate: 2.5-4.5 mg/dL Albumin: 4.0-5.4 g/dL Hemoglobin: 12-16g/dL

Hemoglobin: 11.2 g/dL

 Potassium Sodium Magnesium

Folic acid B12 Thiamin Vit A, D,E, K Iodine

Iron
Zinc Calcium

 Eating Disorders 75%

General Population 12-15%

Case Study
109 eating order participants

Tyramine and Dopamine

Octapamine and Noradeniline

ED Tyramine Dopamine Octapamine Noradrenaline .86 14 1.18 104.26

AN .75 12.85 1.36 105.41

BN 1.09 17.26 .71 101.19

Control .69 2.88 1.29 153.18

 Low BP
Weak heart-smaller No oxygen

Hemoglobin low
Oxygen and nutrients

Low glucose
No carb

Nutritional deficiency

 Low Potassium Diuretics Vomiting Diarrhea Nutrition deficiency

 Disordered Eating
Amenorrhea Osteoporosis

http://www.femaleathletetriad.org/for-professionals/what-is-the-triad/

 Severe weight loss Lower body temperature Dry skin Amenorrhea Episode of fainting Abdominal pain Increased intensity of exercise

Low amount of calories in 24 hour

diet recall
Gag reflex somewhat diminished

Enlarged Salivary glands

Expresses concern of being

overweight/ Social pressures

routine

Claire Bearden

 Sequential stages of puberty ( development of secondary sex characteristics) starting

at Stage 1 and ending at Stage 5

Observational changes in breasts, pubic hair, and height. Stage 1 Prepubertal

Stage 2 Breast begin to slowly develop and sparse growth of pubic hair

Stage 3: Further development of breast and areola, darker, courser, more curled pubic hair
Stage 4: Breast and areola being to mound, adult hair type but covering smaller area Stage 5: Mature stage, adult pubic hair type and quantity, spread to medial thigh.

 Reproductive Hormones- Estrogen and DHEA (male hormone) are lowered

Amenorrhea, osteopenia, fertility issues

Thyroid Hormones are lowered

Metabolism slower

Stress Hormones are higher

Osteopenia, Cognitive disorders

Growth Hormones are lowered

Growth Retardation in young boys and girls

Calorie restrictions, improper nutrition

 Hypothalamus , Pituitary Gland, Amygdala release neurotransmitters Regulate stress, mood, appetite Eating Disorders present abnormalities in
Serotonin: Well-being, anxiety, and appetite Norepinephrine: Stress Hormone Dopamine: Reward-seeking behavior
May explain why people with EDs do not experience pleasure from food or other comforts

Mimi Fetzer

 Doctors specializing in relevant medical complications Dietitians and nutritional counselors Cognitive-behavioral therapists, family therapists, or other psychotherapists

 Restoring normal weight and nutritional intervention

Reduce bone density loss Raise energy levels

Goals
Weight gain 0.5-1 lbs a week (outpatient) and 2-3 lbs a week (hospital)
Start at 1000kcals/day and increase to 2000-3000kcals/day

 Harris-Benedict
~1,300 Kcal/day Activity factor
2 ~2,250 kcal /day

Some hospitals may use a range based off weight

30-35 kcal/kg/day as a start Add more kcals when a healthy weight gain begins

Discover trigger foods Implement a multivitamin Encourage foods high in calcium but low in fat

Low fat milk, broccoli, leafy vegetables Fish, flax seeds, nuts, or chia seeds

Encourage foods with essential fatty acids

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&docid=Uo1j2Qn5fOpFRM&tbnid=oHDC_ITeJef5M:&ved=0CAQQjB0&url=http%3A%2F%2Fhappydietitian.wordpress.com%2F2012%2F02%2F22%2Fwhats-the-hype-about-omega-3-fattyacids%2F&ei=Q2aJUrf1DsegjAL4koDABg&psig=AFQjCNGejC5aLsl2a8PWYmij-tK_MbW1gA&ust=1384822694117724

 Restore normal weight for anorexia nervosa Reduce, and hopefully stop, binge eating and purging Treat physical complications and any associated psychiatric disorders Teach patients proper nutritional habits and how to develop healthy eating patterns

and meal plans

Change patients dysfunctional thoughts about the eating disorder Improve self-control, self-esteem, and behavior Provide family counseling

 Cognitive-Behavioral Therapy
False thinking 4-6 months build up to 3 meals a day Food diary and emotion it brings

Interpersonal Therapy
Depression and anxiety No food or weight issues

Motivational Enhancement Therapy

Understand behaviors concerning foods

Family Therapy
Understand why they have an eating disorder Improve communication skills Teach strategies fro coping with stress and negative feelings

 Hospitalization
Weight loss continues with outpatient 30% below ideal body weight Severe depression (suicidal)

Medical complications
10-12 weeks or until 100% ideal weight is achieved

Family therapy Cognitive Behavior therapy

Nutritional support
Calcium Vit D Zinc

 Medications
Serotonin Reuptake Inhibitor antidepressants
Prozac Zoloft

Cognitive-Behavioral therapy Nutritional Therapy

 60 AN women were placed on either a control regimen, rhIGF-I, oral contraceptive, or

a combination
Results showed that there was not a significant increase in bone mineral density with

the oral contraceptives alone

rhIGF-I had the best results in restoring bone mineral density

Grinspoon S., Thomas L., Miller K., Herzog D., & Klibanski A. (2002). Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. The Journal of Endocrinology & Metabolism , 87(6): 2883-2891.

 Weight gain has been found to be the best for bone mineral density, and menses

restoration
Hormone therapy can aid in the restoration of the bone density in certain bones such

as the hips and spine but not the femoral neck

The belief is that estrogen oral contraceptives can depress the levels of insulin-like

growth factors which is essential for bone mineral density restoration all over the body

 Weight gain 6th months from now

Hospitalized: 48-72 pounds Outpatient: 12-24 pounds

Nutrient needs meet

No fainting, cramping, or headaches

Athletic performance will improve Body image will be healthy

 Viapiana O., Gatti D., Dalle G. R., Todesco T., Rossini M., & Braga V. (2007). Marked

increases in bone mineral density and biochemical markers of bone turnover in patients with anorexia nervosa gaining weight. Bone, 40 (4):10731077.
Legroux-Gerot I., Vignau J., Collier F., & Cortet B. (2008). Factors influencing changes in

bone mineral density in patients with anorexia nervosa-related osteoporosis: the effect of hormone replacement therapy. Calcif Tissue Int., 83 (5):31523
Bergstorm I., Crisby M., Engstrom A., Holcke M., Fored M., Kruse P. A., & Sandburg A.

(2013). Women with anorexia nervosa should not be treated with birth control pills in a bone-sparing effect. ACTA Obstetricia et Gynecologica Scandinavica, 92, 877-880.
Miller K. K., Lee E. E., Lawson E. A., Misra M., Minihan J., Grinspoon S.K., Gleysteen S.,

Mickley D., Herzog D., & Klibanski A. (2006). Determinants of skeletal loss and recovery in anorexia nervosa. Journal of Clinical Endocrinology & Metabolism, 91(8):29312937.
Grinspoon S., Thomas L., Miller K., Herzog D., & Klibanski A. (2002). Effects of

recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. The Journal of Endocrinology & Metabolism , 87(6): 2883-2891.

 Brown JE, Isaacs JS, Krinke UB, et al. Nutrition Through the Life Cycle. Belmont, CA:

Wadsworth Cengage Learning; 2011. National Eating Disorders Association. Types and symptoms of eating disorders. Available at: http://www.nationaleatingdisorders.org/general-information. Accessibility verified November 8, 2013. National Eating Disorders Association. Athletes and eating disorders. Available at: http://www.nationaleatingdisorders.org/athletes-and-eating-disorders. Accessibility verified November 8, 2013. National Institute of Mental Health. Eating disorders. Available at: http://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml. Accessibility verified November 8, 2013. US News Health. Eating disorders. Available at: http://health.usnews.com/healthconditions/mental-health/eating-disorders. Accessibility verified November 8, 2013. Mayo Clinic. Eating disorders. Available at http://www.mayoclinic.com/health/eatingdisorders/DS00294/DSECTION=symptoms. Accessibility verified November 8, 2013.